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I had Doppler ultrasound yesterday which showed obvious reflux in both IJVs.

According to the tech, that is enough info to qualify me for venogram w/angioplasty. Procedure will be done by a vascular surgeon familiar with CCSVI research. I don't know yet if stents are being considered, or if I am willing to consider them at this time.

Do doctors REALLY need to know from MRV exactly where every problem is before they go in?

I just checked Zamboni's 2008 paper and he only did sonography and then venography and NO MRV. So your doctors are following Dr Zamboni's protocol. If sonography shows problems then use venography to look at the veins directly.

Best would be to have all: XRays, MRI/MRV fMRI too; why not; Dopplers; Iron; blood analysis, whatever... Anything, and document it. The problem is testing devices/technicians/competencies availability, and of course; depreciation calculations of devices... And time

The venography X-Ray machine is enough to lead the surgeon to the exact location of the stenosis. Actually, there is no other way for him to know the exact location of the catheters. It gives a real time picture of the blood flow and the vascular structure and detecting a stenosis is a piece of cake. Well, almost...

Happy liberation!!!!!!

sou

Shortest joke: "We may not be able to cure MS but we can manage its symptoms."

My wife is in the same situation - she had a quick doppler, which picked up some turbulence in the left jugular. The IR felt that this was enough to justify a venogram with possible angiogram. He felt that an MRV wasn't really necessary, and was a very expensive procedure to boot.

Algis, it would be wonderful to go into this with as many tests as possible. However, I may end up paying for my ultrasound if ins doesn't cover it. If I don't have to rack up unnecessary charges for other tests, that is fine with me.

Sou, OC and tzootsi your thoughts give me piece of mind.

It is so nice to be a part of such a well informed, supportive network here!

This gets tossed around so much, it needs it's own sticky. It depends on the situation, always. On the patient, the testing protocol, the tech, the insurance and a raft of other issues. Maybe they catch the reflux on UT, maybe not, maybe on MRV they can identify stenosis, maybe not, but I highly doubt any of us can just get a venogram on demand, I think one person did it, the rest need to explore MRV or CT or UT first. If one can get a UT, and the tech can easily identify the reflux, then no, an MRV at that point would be redundant and unnecessary.

If however, the UT is negative, that may, or may not mean much of anything if the proper protocols are not followed, or if the stenosis and resultant reflux is inaccessible to that imaging method. In that case, the few options left are MRV, or the CT version of that, or a venogram, but a venogram is invasive and usually accomplished in an operative setting with some anticipation of a surgical intervention.

It cannot be stressed enough, that just because one method works for one person, doesn't mean it automatically holds true for everyone else. I think anyone that can get the Dx and surgical intervention based solely on UT, has just leapfrogged over a lot of headache and expense!

I think some stenosis and reflux is right there in the middle of the neck or a bit lower and easy to detect, and others are not so easy.

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